Lethal vortioxetine poisoning? A forensic investigation.

Area of Science:

• Forensic Toxicology
• Clinical Pharmacology
• Cardiology

Background:

• Vortioxetine is a newer antidepressant for major depressive disorder, with limited data on overdose toxicity.
• Previous literature includes suicide attempts but lacks detailed toxicological analysis.

Observation:

• A case of a 65-year-old woman with no vital signs, recently prescribed vortioxetine for depression, anxiety, and psychotic attacks.
• Quantification of vortioxetine in blood and organs revealed significantly elevated levels, with no other substances detected.

Findings:

• Blood vortioxetine concentration was 1.197 ng/ml, approximately 35-135 times higher than therapeutic levels.
• Organ concentrations included 804 ng/g in the brain, 8.992 ng/g in the lung, 1.389 ng/g in the liver, and 292 ng/g in the kidney.
• Histological findings suggested sudden cardiac death due to arrhythmia, without evidence of myocardial infarction.

Implications:

• This case suggests that blood vortioxetine concentrations around 1,000 ng/mL may be lethal.
• Cardiac toxicity, potentially leading to fatal arrhythmias, is a likely mechanism of death in severe vortioxetine intoxication.
• Further research is needed to establish definitive toxicological thresholds for vortioxetine overdose.